- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $497.07 / $1,030.72 / $5,091.00
| Facility | | $497.07 | $1,030.72 | $5,091.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $244.33 / $414.54 / $676.96
| Facility | 54 | $244.33 | $414.54 | $676.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $700.72 / $2,932.51 / $6,396.19
| Facility | | $700.72 | $2,932.51 | $6,396.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $709.00 / $709.00 / $735.00
| Facility | | $709.00 | $709.00 | $735.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $361.02 / $654.33 / $1,384.16
| Professional | | $361.02 | $654.33 | $1,384.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.00 / $963.00 / $3,686.00
| Facility | | $165.00 | $963.00 | $3,686.00 |